Advancements in AI Research for Digestive System Diseases

With the “boom” of AI, researchers have made significant progress in assisting clinical disease diagnosis, prediction, and treatment. This article provides an overview of models built using both traditional machine learning methods and deep learning methods, as well as research progress on robotics in digestive system diseases, aiming to provide references for further studies. An application has been developed by domestic and foreign scholars that allows users to upload images of stool samples, which are then analyzed using big data to provide a score for bowel preparation, thereby improving the quality of bowel preparation. In some gastrointestinal diseases, such as Hp infection, Barrett’s esophagus and esophageal cancer, chronic atrophic gastritis and gastric cancer, IBD, etc., artificial intelligence possesses diagnostic capabilities comparable to those of professional endoscopists, and some applications can achieve real-time diagnosis. In the field of liver, gallbladder, and pancreatic diseases, artificial intelligence can assist in preoperative diagnosis using imaging or pathology, and robotic remote operations can be performed during surgery, predicting postoperative risk levels, and more. Different scholars have compared and analyzed various algorithm networks for different diseases to find the best-performing models. On this basis, methods such as the MCA attention mechanism, feature selection, gradient descent, and ensemble models can be introduced to further improve the diagnostic performance of the models. In the future, AI can not only help patients self-manage single or multiple diseases, monitor and manage their own diseases in a standardized and reasonable manner, but also predict and treat digestive system diseases at the genetic level.

Progress in the Study of Laboratory Indicators Related to Acute Pancreatitis

Acute pancreatitis (AP) is one of the more common gastrointestinal diseases in clinics and is characterized by rapid progression, many complications, and high mortality. When it develops into severe pancreatitis, its prognosis is poor. Therefore, early assessment of the degree of inflammatory response plays a crucial role in the treatment plan and prognosis of patients. More and more studies have shown that the levels of D-dimer (D-D), angiotensin-2 (Ang-2), phosphate, heparin-binding protein (HBP), retinol-binding protein-4 (RBP4), and osteoblastic protein (OPN) are closely related to the severity of acute pan-creatitis and can be used as effective indicators for early assessment of AP. In this paper, the research progress of the above indicators in assessing the severity of AP is summarized.

Etitiological Relationship between Hyperlipidemia and Acute Pancreatitis

Hyperlipidemia is a kind of pancreatitis caused by high triglyceride levels in the blood. The morbidity and mortality of this disease continue to increase worldwide, and it has become one of the most common gastrointestinal diseases in developed countries worldwide. Although many studies have been conducted, the pathogenesis still cannot be defined. Many studies have shown that this may be related to the triglyceride decomposition products free fatty acids are the main toxic substances, which can directly damage pancreatic acinar cells and vascular endothelial cells, causing tissue ischemia and acidic environment. Therefore, this paper focuses on the correlation of triglycerides and their decomposition products in plasma and provides evidence on the pathogenesis of AP and the disease progression of AP. Finally, the future potential to prevent and treat acute pancreatitis by some new drugs to reduce plasma triglycerides is summarized.

Research Progress of Intestinal Flora in Colorectal Cancer

Colorectal cancer, as a common malignant tumor, has been increasing in incidence year by year and has become one of the leading causes of death worldwide. Meanwhile, researchers have found a close relationship between dysbiosis of the gut microbiota and colorectal cancer, which has further triggered indepth exploration of the role of gut microbiota in the pathogenesis, diagnosis, and treatment of colorectal cancer. Studies have shown that there are specific microbial changes in colorectal cancer tissues, including enrichment or depletion of certain bacterial species, which may be associated with tumor growth, invasion, and metastasis. Additionally, gut microbiota has been found to be closely linked to tumor microenvironment, tumor immune response, chemotherapy drug metabolism, and other factors. In this context, it is imperative to study the gut microbiota in colorectal cancer. A comprehensive understanding of the interaction between gut microbiota and colorectal cancer is not only helpful in revealing novel mechanisms of colorectal cancer development, but also holds promise in providing new strategies and targets for early diagnosis, individualized treatment, and prevention of colorectal cancer. This review aims to thoroughly discuss the research progress of gut microbiota in colorectal cancer, including its compositional characteristics, its role in the occurrence and development of colorectal cancer, and its potential clinical applications. The goal is to provide references and insights for further research in this field.

Superficial Serrated Adenoma (SuSA): A New Subtype of Serrated Lesions

Superficial serrated adenoma (SuSA) is a new subtype of serrated lesions proposed in recent years, most of which are located in the sigmoid colon or rectum, with typical mixed adenoma and serrated pathological features, and its molecular features are high frequency of KRAS mutation and RSPO fusion or overexpression. At present, it is believed that SuSA has two subtypes: traditional serrated adenoma (TSA)-associated SuSA and isolated SuSA. Solitary SuSA showed faded pedicle-free protuberant lesions under endoscope and lobulated, pp (pit pattern) classification was type II and type IIIH, TSA-associated SuSA showed double-layer eminence, SuSA part showed white flat eminence, pp classification showed type II and IIIH, TSA part showed red tone high eminence, pp was IVH type. SuSA can develop into colorectal cancer through the evolution of TSA, and it can also directly develop into MSS colorectal cancer. In view of the superficial understanding of SuSA and the lack of a complete description of SuSA, this paper review the research progress of SuSA at home and abroad from the origin, endoscope features, histopathological features, molecular biology, differential diagnosis and treatment of SuSA, in order to better promote the understanding and clinical diagnosis of lesions.

Progress in the Study of Inflammatory Bowel Disease Patients with Primary Non-Responsiveness

Inflammatory bowel disease (IBD) is a group of chronic, nonspecific intestinal inflammatory disorders characterized by localized and systemic inflammation. The use of biologic agents in the treatment of IBD patients is widespread, and the occurrence of primary non-responsiveness during treatment is also significant. This review briefly summarizes the possible reasons for primary non-responsiveness in IBD patients, as well as predictive markers and current strategies to address it, providing a theoretical reference for early identification and management of IBD patients who do not respond to treatment.

Progress in the Study of the Hepatoprotective Effect of SGLT2i on NAFLD Patients with T2DM

In recent years, the progress of NAFLD has become an important health problem, and the prevention or delay of progress in NAFLD is a major key point. Whether or not to combine T2MD, people are interested in the mechanisms and efficacy of SGLT2i for NAFLD. In this review, we summarized the current clinical research on SGLT2i for the combination of T2MD’s NAFLD patients, and the latest evidence of external or animal experiments. These evidences will help us to more accurately understand the protective effects of SGLT2i in NAFLD. Lifestyle changes are still essential to prevent and treat NAFLD, and for all kinds of drugs that treat NAFLD in clinical trials, SGLT2i may be one of the promising treatments.

Reciprocal impact of host factors and Helicobacter pylori genotypes on gastric diseases

AIM: To assess the impact of Helicobacter pylori(H. pylori) genotypes and patient age and sex on the development of gastric diseases.METHODS: H. pylori-infected patients(n = 233) referred to the endoscopy unit at Tehran University of Medical Sciences(Tehran,Iran) were diagnosed with chronic gastritis(CG),gastric ulcer(GU),or duodenal ulcer(DU). Brucella blood agar was used for biopsy cultures and H. pylori isolation under microaerobic conditions. H. pylori isolates were confirmed with biochemical tests and through amplification of the 16 S r RNA gene. DNA was extracted from fresh cultures of the H. pylori isolates and used for amplification of vac A alleles and the cag A gene. Statistical analysis was performed to determine the association between H. pylori genotypes,age(< 40 years vs > 40 years) and sex of the patient,and gastric diseases.RESULTS: CG was the most prevalent gastric disease(113/233; 48.5%),compared to GU(64/233; 27.5%)and DU(56/233; 24%). More patients were male,and gastric diseases were more frequent in patients > 40 years(P < 0.05). The percentage of CG and GU patients that were male and female did not show a significant difference; however DU was more common in males(P < 0.05). Interestingly,a diagnosis of CG in patients > 40 years was more common in females(18.5%) than males(11.6%)(P = 0.05),whereas a diagnosis of GU or DU in patients > 40 years was more frequent in males(14.6% vs 10.7% and 12.4% vs 4.3%,respectively). Overall,genotyping of the H. pylori isolates revealed that the vac A s1(82%),vac A m2(70%),and cag A+(72.5%) alleles were more frequent than vac A s2(18%),vac A m1(29.2%),and cag A-(all P < 0.05). The vac A s1m2 cag A+ genotype was the most prevalent within the three disease groups. vac A s1m2 frequency was 56.2% with a similar occurrence in all diagnoses,while vac A s1m1 appeared more often in DU patients(33.9%). A genotype of vac A s2m2 occurred in 15% of isolates and was more common in CG patients(21.2%); vac A s2m1 was the least common genotype(3%). The vac A s1 allele was found to be a risk factor for DU,vac A s2 for CG,and vac A s1 and vac A s2 for GU(all P < 0.05). The vac A s2m2 genotype was associated with the development of CG and GU compared to DU(P < 0.05). No correlation was found between vac A m or cag A and gastric diseases.CONCLUSION: The outcome of H. pylori infection is the result of interaction between bacterial genotypes and the age and sex of infected individuals.

First United Arab Emirates consensus on diagnosis and management of inflammatory bowel diseases:A 2020 Delphi consensus

Ulcerative colitis and Crohn’s disease are the main entities of inflammatory bowel disease characterized by chronic remittent inflammation of the gastrointestinal tract.The incidence and prevalence are on the rise worldwide,and the heterogeneity between patients and within individuals over time is striking.The progressive advance in our understanding of the etiopathogenesis coupled with an unprecedented increase in therapeutic options have changed the management towards evidence-based interventions by clinicians with patients.This guideline was stimulated and supported by the Emirates Gastroenterology and Hepatology Society following a systematic review and a Delphi consensus process that provided evidence-and expert opinion-based recommendations.Comprehensive up-to-date guidance is provided regarding diagnosis,evaluation of disease severity,appropriate and timely use of different investigations,choice of appropriate therapy for induction and remission phase according to disease severity,and management of main complications.

The Mechanism and Research Progress of Ferroptosis in Esophageal Squamous Cell Carcinoma

Esophageal squamous cell carcinoma (ESCC), as the main histological type of esophageal cancer (EC), has the characteristics of high malignant degree, high mortality and tendency to lymph node metastasis. Despite the combination of surgery and chemoradiotherapy, ECSS has a poor prognosis. Ferroptosis is a newly discovered iron-dependent programmed cell death pattern characterized by the accumulation of lipid peroxidation and characteristic morphological changes of mitochondria. It regulates the growth and invasion of cancer cells in various tumors such as gastric cancer and pancreatic cancer. In this article, we mainly introduce the ferroptosis regulatory mechanism in ESCC, hoping to provide a new direction and ideas for the treatment of ECSS.

Organized physical activity and sedentary behaviors in children and adolescents with autism spectrum disorder,cerebral palsy,and intellectual disability

BACKGROUND There is little data on physical activity(PA),organized PA(OPA),and sedentary behaviors in autism spectrum disorders(ASD)and other neurodevelopmental disorders in developing countries.AIM To examine OPA,non-OPA,and sedentary behaviors and their associated factors in children and adolescents with ASD,cerebral palsy(CP),and intellectual disability(ID).METHODS A total of 1020 children and adolescents with ASD,CP,and ID were assessed regarding the child and family information as well as the Children’s Leisure Activities Study Survey.RESULTS The results showed that the OPA level was significantly lower than non-OPA in all groups.Furthermore,the OPA level was significantly lower in the CP group compared to ASD and ID groups(P<0.001).Also,moderate(P<0.001),vigorous(P<0.05),and total(P<0.001)physical activity levels were significantly different between all three groups,with the values being higher in the ASD group compared to the other two.The mean of the total sedentary behavior duration in the ASD group(1819.4 min/week,SD:1680)was significantly lower than in the CP group(2687 min/week,SD:2673)(P=0.007)but not ID group(2176 min/week,SD:2168.9)(P=0.525).CONCLUSION Our findings remark on the participation rate of PA,OPA,and sedentary behaviors of children and adolescents with ASD,CP,and ID in a developing country.In contrast,the need for developing standards of PA/OPA participation in neurodevelopmental disorders is discussed.

Cellular zinc metabolism and zinc signaling:from biological functions to diseases and therapeutic targets

Zinc metabolism at the cellular level is critical for many biological processes in the body.A key observation is the disruption of cellular homeostasis,often coinciding with disease progression.As an essential factor in maintaining cellular equilibrium,cellular zinc has been increasingly spotlighted in the context of disease development.Extensive research suggests zinc’s involvement in promoting malignancy and invasion in cancer cells,despite its low tissue concentration.This has led to a growing body of literature investigating zinc’s cellular metabolism,particularly the functions of zinc transporters and storage mechanisms during cancer progression.Zinc transportation is under the control of two major transporter families:SLC30(ZnT)for the excretion of zinc and SLC39(ZIP)for the zinc intake.Additionally,the storage of this essential element is predominantly mediated by metallothioneins(MTs).This review consolidates knowledge on the critical functions of cellular zinc signaling and underscores potential molecular pathways linking zinc metabolism to disease progression,with a special focus on cancer.We also compile a summary of clinical trials involving zinc ions.Given the main localization of zinc transporters at the cell membrane,the potential for targeted therapies,including small molecules and monoclonal antibodies,offers promising avenues for future exploration.

2014年上海国际消化系统疾病会议纪要

上海国际消化系统疾病会议暨国家级脂肪性肝病诊疗新进展学习班（2014-03-03-238）和特殊类型炎症性肠病诊治新进展学习班（2014-03-03-042），由上海交通大学医学院附属新华医院、美国克里夫兰医学基金会、中国工程院医药卫生学部联合主办，《实用肝脏病杂志》编辑部、上海市医学会肝病学分会、中国医师协会脂肪性肝病专家委员会、上海市科学技术委员会协办，于2014年9月11日至13日在上海隆重召开。大会主席庄辉院士及徐卫国、ArthurMeCul—lough教授、执行主席范建高和ShenBo教授主持了会议，演讲专家来自美国、德国、西班牙、新加坡和我国大陆、香港、台北等地，内容涉及肥胖症、酒精滥用及其相关肝病和炎症性肠病的内科、内窥镜诊治和外科手术处理的热点与难点问题，600余名医务人员（其中境外代表19人）参加了此次盛会。本文简要介绍此次大会各国专家的主要演讲内容。 1非酒精性脂肪性肝病（NAFLD）

Biliary complications following liver transplantation

Biliary tract complications are the most common complications after liver transplantation.These complications are encountered more commonly as a result of increased number of liver transplantations and the prolonged survival of transplant patients.Biliary complications remain a major source of morbidity in liver transplant patients,with an incidence of 5%-32%.Post liver transplantation biliary complications include strictures(anastomotic and non-anastomotic),leaks,stones,sphincter of Oddi dysfunction,and recurrence of primary biliary disease such as primary sclerosing cholangitis and primary biliary cirrhosis.The risk of occurrence of a specific biliary complication is related to the type of biliary reconstruction performed at the time of liver transplantation.In this article we seek to review the major biliary complications and their relation to the type of biliary reconstruction performed at the time of liver tranplantation.

Endoscopic management of difficult common bile duct stones

Endoscopy is widely accepted as the first treatment option in the management of bile duct stones.In this review we focus on the alternative endoscopic modalities for the management of difficult common bile duct stones.Most biliary stones can be removed with an extraction balloon,extraction basket or mechanical lithotripsy after endoscopic sphincterotomy.Endoscopic papillary balloon dilation with or without endoscopic sphincterotomy or mechanical lithotripsy has been shown to be effective for management of difficult to remove bile duct stones in selected patients.Ductal clearance can be safely achieved with peroral cholangioscopy guided laser or electrohydraulic lithotripsy in most cases where other endoscopic treatment modalities have failed.Biliary stenting may be an alternative treatment option for frail and elderly patients or those with serious co morbidities.

NSAIDs for prevention of pancreatitis after endoscopic retrograde cholangiopancreatography:Ready for prime time?

Acute pancreatitis is the most common and the most fearful complication of endoscopic retrograde cholangiopancreatography (ERCP).Prevention of post-ERCP pancreatitis has therefore been of great interest to endoscopists performing ERCP procedures.So far,only pancreatic duct stenting during ERCP and rectal administration of a non-steroidal anti-inflammatory drug (NSAID) prior to or immediately after ERCP have been consistently shown to be effective for prevention of post-ERCP pancreatitis.This commentary focuses on a short discussion about the rates,mechanisms,and risk factors for post-ERCP pancreatitis,and effective means for its prevention with emphasis on the use of NSAIDs including a recent clinical trial published in The New England Journal of Medicine by Elmunzer et al.

Choledochal cysts: Similarities and differences between Asian and Western countries

Choledochal cysts(CCs)are rare bile duct dilatations,intra-and/or extrahepatic,and have higher prevalence in the Asian population compared to Western populations.Most of the current literature on CC disease originates from Asia where these entities are most prevalent.They are thought to arise from an anomalous pancreaticobiliary junction,which are congenital anomalies between pancreatic and bile ducts.Some similarities in presentation between Eastern and Western patients exist such as female predominance,however,contemporary studies suggest that Asian patients may be more symptomatic on presentation.Even though CC disease presents with an increased malignant risk reported to be more than 10%after the second decade of life in Asian patients,this risk may be overstated in Western populations.Despite this difference in cancer risk,management guidelines for all patients with CC are based predominantly on observations reported from Asia where it is recommended that all CCs should be excised out of concern for the presence or development of biliary tract cancer.

Aflatoxins,hepatocellular carcinoma and public health

Hepatocellular carcinoma(HCC) is one of the leading causes of cancer deaths worldwide,primarily affecting populations in the developing countries.Aflatoxin,a food contaminant produced by the fungi Aspergillus flavus and Aspergillus parasiticus,is a known human carcinogen that has been shown to be a causative agent in the pathogenesis of HCC.Aflatoxin can affect a wide range of food commodities including corns,oilseeds,spices,and tree nuts as well as milk,meat,and dried fruit.Many factors affect the growth of Aspergillus fungi and the level of aflatoxin contamination in food.Drought stress is one of the factors that increase susceptibility of plants to Aspergillus and thus aflatoxin contamination.A recent drought is thought to be responsible for finding of trace amounts of aflatoxin in some of the corn harvested in the United States.Although it's too soon to know whether aflatoxin will be a significant problem,since United States is the world's largest corn producer and exporter,this has raised alarm bells.Strict regulations and testing of finished foods and feeds in the United States should prevent a major health scare,and prevent human exposure to deleterious levels of aflatoxin.Unfortunately,such regulations and testing are not in place in many countries.The purpose of this editorial is to summarize the current knowledge on association of aflatoxin and HCC,encourage future research and draw attention to this global public health issue.

Hepatocellular carcinoma: From diagnosis to treatment

Hepatocellular carcinoma(HCC) is the sixth most prevalent malignancy worldwide and is a rising cause of cancer related mortality. Risk factors for HCC are well documented and effective surveillance and early diagnosis allow for curative therapies. The majority of HCC appears to be caused by cirrhosis from chronic hepatitis B and hepatitis C virus. Preventive strategies include vaccination programs and anti-viral treatments.Surveillance with ultrasonography detects early stage disease and improves survival rates. Many treatment options exist for individuals with HCC and are determined by stage of presentation. Liver transplantation is offered to patients who are within the Milan criteria and are not candidates for hepatic resection. In patients with advanced stage disease, sorafenib shows some survival benefit.

Effects of n-3 polyunsaturated fatty acids from seal oils on nonalcoholic fatty liver disease associated with hyperlipidemia

AIM: To investigate the efficacy and safety of n-3 polyunsaturated fatty acids (PUFA) from seal oils for patients with nonalcoholic fatty liver disease (NAFLD) associated with hyperlipidemia. METHODS: One hundred and forty-four patients with NAFLD associated with hyperlipidemia were included in the 24-wk, randomized, controlled trial. The patients were randomized into two groups. Group A (n = 72) received recommended diet and 2 g n-3 PUFA from seal oils, three times a day. Group B (n = 72) received recommended diet and 2 g placebo, three times a day. Primary endpoints were fatty liver assessed by symptom scores, liver alanine aminotransferase (ALT) and serum lipid levels after 8, 12, 16, and 24 wk. Hepatic fat inf iltration was detected by ultrasonography at weeks 12 and 24 after treatment. RESULTS: A total of 134 patients (66 in group A, 68 in group B) were included in the study except for 10 patients who were excluded from the study. After 24 wk of treatment, no change was observed in body weight, fasting blood glucose (FBG), renal function and blood cells of these patients. Total symptom scores, ALT and triglyceride (TG) levels decreased more significantly in group A than in group B (P < 0.05). As expected, there was a tendency toward improvement in aspartate aminotransferase (AST), γ-glutamyltranspeptidase (GGT), and total cholesterol (TCHO) and high- density lipoprotein (HDL) cholesterol levels (P < 0.05) after administration in the two groups. However, no significant differences were found between the two groups. The values of low-density lipoprotein (LDL) were significantly improved in group A (P < 0.05), but no significant change was found in group B at different time points and after a 24-wk treatment. After treatment, complete fatty liver regression was observed in 19.70% (13/66) of the patients, and an overall reduction was found in 53.03% (35/66) of the patients in group A. In contrast, in group B, only f ive patients (7.35%, 5/68) achieved complete fatty liver regression (P = 0.04), whereas 24 patients (35.29%, 24/68) had a certain improvement in fatty liver (P = 0.04). No serious adverse events occurred in all the patients who completed the treatment. CONCLUSION: Our results indicate that n-3 PUFA from seal oils is safe and effi cacious for patients with NAFLD associated with hyperlipidemia and can improve their total symptom scores, ALT, serum lipid levels and normalization of ultrasonographic evidence. Further study is needed to confi rm these results.